ICU碳青霉烯耐药铜绿假单胞菌肺部感染危险因素分析

摘要

Objective To study the infective characteristics and risk factors of carbapenem resistant Pseudomonas aeruginosa (CRPA ) isolate from the intensive care unit(ICU) patients, in order to provide the reference for the infection control. Methods This study was a retrospective review of a hospital epidemiology data base and included 516 isolates of Pseudomonas aeruginosa (PA)from ICU. Using the carbapenem sensitive Pseudomonas aeruginosa isolates as the control group, the risk factors for the acquisition of CRPA were analyzed. Results Of the 516 PA isolates 26. 17% (135) were carbapenemase resistance. Compared the carbapenem resistant Pseudomonas aeruginosa group with the sensitive group,in addition to ciprofloxacin and levofloxacin, the other antibiotic resistance rates were statistically significant difference. The carbapenem resistant Pseudomonas aeruginosa infection related factors were analyzed, mechanical ventilation(OR= 2. 407;95%CI:l.609 — 3. 601) , fiber bronchoscopy using ( OR= 1. 987 ; 95 % CI:1. 116-3. 537),the score of PACHE II>20(OR = 2. 558 ;95%CI:1. 579-4. 145),the use of antibiotics (including carbapenem, cephalosporins and in combination) and underlying diseases (COPT and nerve damage)were the independent risk factors. Conclusion The epidemic of CRPA was extremely serious,especially in ICU. The drug resistance of CRPA isoaltes is strong. Its infection or colonization in patients causes a high mortality rate. CRPA infection has multiple independent risk factors,to strengthen the controlof these independent risk factor can effectively prevent CRPA infection spread.%目的 研究重症监护病房碳青霉烯耐药铜绿假单胞菌(CRPA)肺部感染危险因素,为临床有效控制其感染提供依据.方法对本院2011～2012年6月ICU分离的516株铜绿假单胞菌流行病学资料进行回顾性研究.以碳青霉烯敏感铜绿假单胞菌(CSPA)做为对照组,对碳青霉烯耐药铜绿假单胞菌的危险因素进行单因素及多因素Logistic回归分析.结果 516株铜绿假单胞菌中有135株为碳青霉烯耐药株,占26.17％.铜绿假单胞菌碳青霉烯耐药组与非耐药组耐药率比较发现,除对环丙沙星和左旋氧氟沙星的耐药率差异无统计学意义外,对其他测试的抗生素耐药率差异均具有统计学意义.对碳青霉烯耐药铜绿假单胞菌感染相关的因素进行Logistic多因素回归分析发现,机械通气(OR=2.407;95％CI:1.609～3.601)、纤维支气管镜(OR=1.987;95％CI:1.116～3.537)、和PACHEⅡ评分大于20(OR=2.558;95％CI:1.579～4.145)以及抗菌药物的使用(包括碳青霉烯类、头孢菌素类和联合用药)和基础疾病(COPT和神经损伤)为其独立危险因素.结论 ICU呼吸道分离铜绿假单胞菌碳青霉烯耐药株流行严重,碳青霉烯耐药株的耐药性强,感染或定植患者的平均住院时间长,病死率高.碳青霉烯耐药株肺部感染具有多个独立危险因素,加强对这些独立危险因素的控制可有效预防碳青霉烯耐药铜绿假单胞菌的感染扩散.